The Society of Black Academic Surgeons

The Asa Yancey lecture: swimming against the current:building strength through adversity

Carlos A. Pellegrini, M.D.

Department of Surgery, University of Washington, Box 356410, 1959 Pacific St. NE, Seattle, WA 98195-6410, USA

Adversity has the effect of eliciting talents; which inprosperous circumstances would have lain dormant.

Horace (Roman poet, 658 BC)President Stain, Distinguished Members, and Ladies and

Gentlemen:I stand before you today proud to have been given the

privilege of honorary membership in this society and thank-ful to you for bestowing on me an honor that I shall alwayscherish.

I stand before you today extremely happy to have pre-vailed upon you to host the 2009 meeting of the Society ofBlack Academic Surgeons in Seattle. We most certainlyhope you will feel welcome in the Emerald City and dis-cover its jewel: the University of Washington.

I stand before you thankful to President Stain for havingasked me to deliver the Asa Yancey Lecture during this, hismeeting. I met Steve many years ago when he was a juniorfaculty member at the University of Southern California andhave been delighted to see his meteoric progress in theworld of academic surgery, now chair of a department,president of the Society of Black Academic Surgeons, andabout to become chair of the American Board of Surgery.

Also, I stand before you humbled to honor Dr. Asa Yancey,a surgeon who embodies many of the values I shall discusswith you today. He was a pioneer, attending one of the topmedical schools in this country at a time when it was notcommon for an African American to be able to do so. He was

an innovator, and developed the key changes in the Swensonsurgery for megacolon, now known as the Soave procedure,publishing them in the Journal of the National Medical Asso-ciation1 some 12 years before Soave himself published hisarticle.2 He had the ability and the courage that allowed him torise to leadership positions both at the Tuskegee VeteransAdministration Hospital and at Emory, a testimony that adver-sity can be overcome with hard work and perseverance.

With President Stains blessing I chose a topic that isvery personal to me and I know is very personal to many ofyou here today: adversity and how we gain the strength tomove forward. Because the SBAS bestowed an honorarymembership upon me and because I do not know most ofyou, it seemed as if this was an appropriate occasion for meto share a piece of my life, to describe the first time I facedadversity and to reflect on ways that helped me overcome itand reach a position of leadership in our society.

My credentials on this subject are just 2: having beenthere and having carefully reflected on the ways that I usedto navigate through difficulties. In the process I have bor-rowed thoughts from my own heroes and I will offer themto you throughout my presentation for they describe in amore elegant way what I truly believe.

I believe that we build strength when we face the barriersthat are put in our path. My first encounter with a major barrierin the path of my life was the realization that I had to leave thecountry of my birth and start a new life in a totally differentenvironment. I had been born in Argentina and I loved thecountry. Indeed, Argentina had much to offer: rich in naturalresources and the second largest country in South America itused to enjoy a privileged financial, economic, and educationalposition. However, starting in the 1940s Argentina underwenta profound sociopolitical change. Repetitive military coups didaway with democracy and created political chaos and instabil-ity. As the leadership eroded, or perhaps because of it, Argen-

Presented at the 17th Annual Meeting of the Society of Black Aca-demic Surgeons, April 1720, 2008, Cleveland, OH.

* Corresponding author: Tel.: !1-206-543-3106; fax: !1-206-685-6912.

E-mail address: pellegri@u.washington.eduManuscript received May 21, 2008; revised manuscript August 26,

2008

0002-9610/$ - see front matter 2009 Published by Elsevier Inc.doi:10.1016/j.amjsurg.2008.08.014

The American Journal of Surgery (2009) 197, 142146

tina developed a moral crisis of unprecedented magnitude.People reacted to this moral crisis with a substantial change inattitude. Indeed, concern about themselves, egoism, disrespectfor the rights of others, and acceptance of corruption becamethe norm for the average citizen, creating an environment Ibelieved I could not accept. I tried my very best to change theprevailing attitudes that surrounded me, but I failed. Personalreasons beyond the scope of this talk made it imperative for meto leave the country of my birth and to try to start a completelynew life when I was 27 years old. I felt the rug had been pulledout from under me.

I arrived in the United States on the morning of August18th, 1975. My means were very limited, after selling all myworldly possessions I had purchased a 1-way ticket to NewYork and had $92 left in my pockets. However, I had mymedical education, I had completed my surgical residency,and I spoke English fairly well; thus, compared with otherimmigrants, I had a fair amount.

I had met Dr. David Skinner in 1971 in Argentina andwritten to him in 1975, confiding my need to leave. I hadarranged for a job as an assistant in his laboratory. I stillremember arriving at the train station in Chicago, a balmy95F, without a place to stay, without a friend, and with myvery small amount of money. I had received a letter thatdirected me to go to the International House at the Univer-sity of Chicago, but when I got there I learned they expectedme to pay 3 days in advance and I did not have enoughmoney. So, instead I returned to the hospital and waitedthere until the morning of the next day to meet my new boss.

That evening I found out that you never know what lifehas in store for you. Indeed, it was during that time ofwaiting and roaming around the hospital that I saw a signwith an offer of $475 for someone willing to be a researchsubject. The sign indicated that 1 would have to stay in theresearch unit of the hospital for 14 days. The person wouldbe allowed to leave the room, but needed to be available forblood draws every 6 hours and urine and stool collection.The investigators were studying the pharmacokinetics of anewly developed antidepressant. I thought this was manna,coming directly to me from Heaven! I volunteered and wasaccepted into the study, thus, instead of moving my onlybag to the International House I moved directly into North2, which then was the Clinical Research Unit at the Uni-versity of Chicago Hospitals and Clinics.

Everything in life is relative, but think of my situationthen and picture me that evening when I was alone in a largeroom, with access to free food, nice people looking after myneeds, and even a television. I thought of myself as a king.When the psychiatrist investigators who were studying theeffects of this new drug interviewed me the first day afterinjecting the drug and I told them I felt like a king, theyexchanged looks that told me they would never have a clueof what my life had beenor was about to become.

During the initial 2 weeks I came to my laboratory veryearly, making sure that I was there before Dr. Skinner cameto work and was there when he was leaving for home. When

I reluctantly left North 2, a rich man, with more than $400,my original bag, and 2 bags full of nonperishable food, Irented my first studio and felt now more like an emperor.The next 6 months would define the rest of my life.

Indeed, it became apparent that I had impressed Dr.Skinner who slowly took me under his wing. As he startedasking me questions of what I wanted to do I realized thatI was telling him what I thought I could achieve, not nec-essarily what I wanted. I had always admired academicsurgery and I had always wanted to be a professor ofsurgery. Eventually, I was able to articulate for him, andperhaps for myself, what my goals would have been if I hadremained in Argentina. He promptly told me that if that wasmy goal, I should get my credentials and my credentialswould be obtained only if I joined a residency program andessentially started all over again and repeated my surgicaltraining. Initially, I was devastated by this prospect, but Idecided to bite the bullet, to set my aim high, and to givemyself a chance. I applied to every conceivable program,but it seemed that no one was interested in offering me eventhe possibility for an interview. I remember feeling shame-ful and down every time I received another thin letter withjust a few lines of apology for not offering me an interview,but I went on and eventually I was offered a preliminaryposition at the University of Chicago in their internshipprogram.

All of a sudden Chicago looked brighter to me, and after1 year I got an offer to become a categoric resident, and byJuly of 1979, 4 years after I had arrived in the United States,I had completed a residency and was ready to take myboards.

As I reflect on my feelings during those first few years,the most prevalent sensation was that of having lost myanchor. What do I mean by that? As human beings grow upthey develop language, modes of interaction, a taste formusic, food, sounds, a way of living, a whole series ofthings that become the core of ones existence without everreally realizing this is happening. These things provide ananchor to life itself, much like health does. We do not thinkabout health, but it is only because it is there that we can doall the things that we do and that we can enjoy life as we do.

When the anchor is down the boat is still, quiet, peaceful.Nobody thinks of the anchor, nobody talks about the anchor,but it is there. It is only if the anchor suddenly disappearsthat the boat starts drifting without a specific direction. It isonly when one loses their health that one realizes what itwas like to have it. That is what I think happens to humanbeings when they suddenly are uprooted from their tradi-tions and immersed in a totally different environment. Thatwas the root of my adversity, others, I am sure some in thisroom, have faced prejudice instead of uprooting, or losses inyour life of one shape or another. I am firmly convinced thatthe ability to recover the anchor, as I call it, is the only wayto inner peace and happiness. I was lucky to recover mine,I hope that those of you who may be sitting here todaywithout one will do the same because that is what I think

143C.A. Pellegrini Asa Yancey lecture

you need to do first to overcome adversity, and to moveforward in your life and your profession you have to havesomething that gives meaning to it all.

Overcoming adversity

I will share with you some simple rules, some observa-tions that I have either learned or stumbled upon during mylife. These 8 rules (Table 1) deal with ways that I believewill best position a person to deal with, and eventuallyovercome, adversity. I have found that following theserules, one not only can overcome adversity but, most im-portantly, emerge on the other side stronger and betterprepared for the next challenge; just like the swimmer whotrains against the currents eventually develops the musclethat allows her to get ahead in the race. And, just like theswimmer, be prepared to lose some and hopefully to winsome races.

Rule 1

Get an anchor, something that will give you the stabilitythat you need when the seas get rough, something that willalways keep your upside up. My anchors are my wife andmy 2 sons.

Simple? It is simple. So simple, yet so meaningful. Thisis my inner core, this is what gives meaning to my life. Iinvite you to ask yourself if you have that corewhateverit might be, because I submit to you that this is the singlemost important ingredient to be successful.

Rule 2

Set your goals. Do not be afraid of setting them high. Mygood friend David Tapper, a fellow of the American Collegeof Surgeons and the director of the Colleges Surgical Fo-rum for many years, entitled his presidential address to theAmerican Pediatric Surgical Association, The Achieve-ment of Audacious Goals.3 In it he described how to setyour aim highhow to define audacious goals, even if you

cannot reach them and you know so. At that time Davidknew that he was dying from cancer, but he believed thatthere was no reason not to continue in the general directionof the goals he had set for himself.

Setting a lofty goal provides you with a direction. In fact,I believe that one should be a dreamer when setting theirgoal, but one should be realistic when measuring the dis-tance to the goal. Then, once the goal is set, keep movingtowards that goal. It is easy to get off track.

Not just your enemies but also your friends, sometimeswith the best of intentions, will try to distract you from thegoal. Keep an eye on it. Having a clear direction in yourprofessional life will dictate which committees you workon, which groups you join, to whom you say yes, and towhom you say no.

William Jennings Bryan said, Destiny is not a matter ofchance, it is a matter of choice; it is not a thing to be waitedfor, it is a thing to be achieved.4

Also, Colin Powell, in his address to the graduating classof Morris High School in the Bronx said, you can beanything you want to be. But wanting to be isnt enough.Dreaming about it isnt enough. Youve got to study for it,work for it, fight for it with all your heart and soul. Rejectthe easy path of victimhood. Dare to take the harder path ofwork and commitment, a path that leads somewhere.5

Rule 3

Get a mentor. A mentor will facilitate your navigationtowards the goal you set.

During my formative yearsmy first 5 years in theUnited StatesI had 2 incredible mentors. Notice that Isaid, Get a mentor, I did not say, Wait until someonecomes to you and says, I want to be your mentor. That,my friends, does not happen.

As my good friend Norm Beauchamp, the Chair of Ra-diology at the University of Washington, says, you have torecruit your mentor. This process can be tricky. My recom-mendation is that you look for someone with whom youclick and then try to get close to this person and show thisperson your own values and character. Mentorship is built intrust, it is an act of love in a way. It is not just receiving, itis a 2-way street. You want to find someone who enjoysdoing what they do, who shows real pleasure in what theydo. Only those who enjoy what they do will enjoy takingyou there. As Norman Schwarzkopf so elegantly put it,You cant help someone get up a hill without getting closerto the top yourself.

Rule 4

Knock at the door. Do not be afraid of knocking and donot be discouraged if the door does not open. Knock againor move to another door. When I first applied for residencytraining I got nothing but rejection letters. It did not take melong to figure out that those doors, the traditional paths,

Table 1 Eight rules

1. Get an anchor Decide what gives meaning to yourlife

2. Set your goal Aim high, follow the direction3. Get a mentor Do not wait for someone to come to

you4. Knock at the door Seek opportunity5. Take some risks Do something with passion, defy the

odds6. Believe in yourself Every person is unique, make a

difference7. Enjoy the process Success is not a destination8. Keep a balance Put important things first

144 The American Journal of Surgery, Vol 197, No 2, February 2009

were going to remain closed to me, so I found another path.I started working with a number of attendings at the Uni-versity of Chicago, and slowly convinced at least some ofthem that it was worth giving me a chance for a year.

Rule 5

Take some risks in life. A life that is perfectly safe andwithout risks is unlikely to bring you the happiness you areafter. Remember, a boat is always safer in the docks, butboats were not meant to be docked, they were meant to sail.The following quote, which has been attributed to MarkTwain, is a perfect example of what I mean, Twenty yearsfrom now you will be more disappointed by the things thatyou didnt do than the ones you did do. So throw off thebowlines. Sail away from the safe harbor. Catch the tradewinds in your sails. Explore. Dream. Discover.6

While we are talking about taking some risks, once in awhile break the mold. Do not be afraid of doing somethingdifferent, something others do not do, if you are convincedthat it is right. I had immigrated to this country, I had fallenin love with the country, I was a surgeon, and we were atwar. So, I joined the Army. I could use my skills and servethe United States, while serving the greater good of human-ity. Some questioned the wisdom of my choice. They havethe right to do it. Do not let that ever stop you from doingwhat you really want to do, what feels good to you. Notevery day, not as a routine, but sometimes you have to breakthe mold. Surprise yourself, surprise your friends. Shockyour enemies.

Rule 6

Believe in yourself. You will not be able to follow rules4 and 5 unless you also follow rule number 6: believe inyourself. Have faith in yourself. If you do not, you cannotask others to believe in you, it is that simple. There is nomentor that will take you on if you do not believe inyourself. You are unique, because every human being isunique. Never underestimate your ability to make positivechange. Act as if someone is watching, even if you knowyou are alone. Stop at a red light, even if it is 3 AM, be kindto someone even if you are never going to see this personagain. You can make a differencenever forget that.

As you go through life and as you take risks you willoccasionally fail. Failure will rock that belief in self. Youshould remember that failure is part of life. Take failure asanother barrier that needs to be overcome, learn from fail-ure, emerge from failure a stronger person. Thus, convertfailure into a lesson, learn from it. If you do not fail, youwill never know whether you can stand up.

There may be a time, however, for whatever reason,usually associated with 1 or 2 major failures, that your faithin yourself will really be shaken. If it ever gets that bad, andyou do lose your confidence, then stop and go back to rulenumber 1: check your anchor, check your inner core.

If it is there, then you are okay. If it is not, then you needto find your anchor again and redefine your life. Some turnto religion, some turn to volunteering, some find anotherperson to share their life withit does not matteryouneed the anchor and until you have defined it again, anddifferently if that is needed, you will not be able to moveforward in a way that is meaningful to you. It may not beapparent to others, but you need to have your inner core tosucceed for yourself.

Rule 7

Enjoy the process. I often find that many of the humanbeings with whom I interact, students, residents, and fac-ulty, in the early stages of their careers tend to postpone theenjoyment of their lives in pursuit of their goal. It is as ifsomehow, the prevailing idea is that once they reach theirgoal (usually the next step in their career), then life willbegin in full. Wait until I graduate, or Just wait until theresidency is over, is usually the excuse. I think you have tobe careful because if you postpone the enjoyment until youreach some intermediate goal in your life, you may neverhave time to smell the flowers. There is always anotherthing to do, another hill to climb, another obstacle to nego-tiate.

American writer and businesswoman Satenig St. Mariesaid, Success is never a destinationit is a journey. Thus,my theory is that you look carefully at the process itself andensure that your philosophy is centered in enjoying theprocess. Reaching goals should be celebrated as such, thosegreat moments in life that bring joy and pride to a personand those who love that person. Just make certain it does notbecome an all-consuming affair and that some enjoyment isderived every day from your work. If you want to knowwhether you are in the right job, ask yourself if you areenjoying the process. When you stop enjoying the processfor too long, you may want to redefine your goals.

To enjoy the process I have 4 pieces of advice. First,laugh, laugh often, and laugh a lot. Take your job seriously,but do not take yourself that seriously. Laugh, primarily atyourself. Make jokes once in a while and make others laugh.Laughter is healthy.

Second, do good for someone every time you can. Bekind. Be humble. In the end, kindness and humbleness willtake you a lot further than arrogance.

Third, do not feel victimized. We can always find areason to feel like a victim, If I only had this . . . and ifonly . . . whatever. Life is not meant to be fair. Cryingabout what others are doing to you will never elicit com-passion. Take the problem as a challenge. Just think that youare swimming against the currentbut put your mind atrest by thinking that because of it you will build morestrength than the lucky ones who are going the easy way!

Fourth, get rid of prejudice. Accept others, interact withothers, look for the good in others. I promise you will finditat least most of the time. A few years ago I was corre-sponding with a friend in the United Kingdom about this

145C.A. Pellegrini Asa Yancey lecture

very issue. His e-mail to me touches the heart of this issueso clearly. It always fascinates me that we all accumulateprejudices about people as members of ethnic, religious,social, and other groups, yet whichever company one entersthere emerges a mix of wonderful inspiring people, inter-mediatesand villains (RM Kirk, personal communica-tion).

Rule 8

Keep the balance. Easier said than done, isnt it? Toexplain what I mean by keeping the balance I would like touse a story that someone once told me. The story of aphilosophy professor who is asked by her students to ex-plain what balance is and how to keep balance in life.

Instead of talking, she picked up a very large and emptyjar and proceeded to fill it with golf balls.

She then asked the students if the jar was full. Theyagreed that it was. So the professor then picked up a box ofpebbles and poured them into the jar. After shaking the jara bit, the pebbles filled the open areas between the golfballs. The professor then asked the students if the jar wasfull. They agreed that it was.

The professor next picked up a box of sand and pouredit into the jar. Of course, the sand filled up everything else.She asked once more if the jar was full. The studentsresponded with a unanimous, yes.

The professor then produced 2 cans of beer from underthe table and poured the entire contents into the jar, whichfilled the empty spaces between the granules of sand.

The professor then said,Now, I submit to you that this jar represents your life.

The golf balls are the important thingsyour family, yourchildren, your health, your friends, and your passions. These

are the things that provide an anchor to your life, the thingsthat, even if you lost everything else, you would be willingto live for. The pebbles are the other things that matter likeyour job, your house, your car. The sand is everythingelsethe small stuff. The important thing to realize is thatthere is an order in your life. For example, if you put thesand in first, you can easily fill the jar with things that reallydo not matter and you would be unable to put the pebbles or,most importantly, the golf balls. In fact, unless the golf ballsgo first in the jar of lifethey are left out. Pay attention tothe things that are critical to your happiness. There willalways be time for the smaller things.

One of the students raised her hand and inquired what thebeer represented. The professor smiled. Im glad youasked. It just goes to show you that no matter how full yourlife may seem, theres always room for a couple of beerswith your best friend.

Ladies and gentlemen, thank you for allowing me toshare a piece of my life and a few reflections with youtoday.

References

1. Yancey AG, Cromartie JE, Ford JR, et al. A modification of theSwenson technique for congenital megacolon. J Natl Med Assoc 1952;44:35663.

2. Soave F. Hirschsprungs disease: a new surgical technique. Arch DisChild 1964;39:11624.

3. Tapper D. The achievement of audacious goals. J Pediatr Surg 2002;37:26976.

4. Bryan WJ. Americas mission (speech). Washington, DC: 1899.5. Powell CL, Perscio JE. My American Journey. New York: Random

House; 1995:533.6. Available from: http://www.twainquotes.com/Discovery.html. Accessed

March 3, 2008.

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